目的:比较局麻和全麻下行股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗高危患者股骨转子间骨折的临床疗效。方法:2018年2月至2019年2月因股骨转子间骨折行PFNA手术的32例患者,16例局麻下行PFNA手术,男9例,女7例,...目的:比较局麻和全麻下行股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗高危患者股骨转子间骨折的临床疗效。方法:2018年2月至2019年2月因股骨转子间骨折行PFNA手术的32例患者,16例局麻下行PFNA手术,男9例,女7例,年龄54~98(82.43±9.30)岁,住院时间(10.94±5.30)d;16例全麻下行PFNA手术,男6例,女10例,年龄51~83(72.69±9.48)岁,住院时间(12.88±4.12)d。记录患者性别、年龄、骨折AO分型、术前VAS疼痛评分、术前ASA病情分级、术后第1天静息状态VAS评分、住院费用及住院时长。结果:32例患者术后均恢复较好,伤口愈合良好,恢复下肢活动能力。患者术后平均随访时间4.6个月。两组患者年龄差异有统计学意义(P<0.05);患者性别比、骨折AO分型、术前VAS疼痛评分比较,差异无统计学意义(P>0.05)。两组ASA分级比较差异无统计学意义(P>0.05),但两组ASA≥Ⅲ级患者比较差异有统计学意义(P<0.05)。局麻组术中VAS疼痛评分4.19±1.50,患者尚可忍受。两组术后第1天静息状态VAS评分、平均住院费用及平均住院时长比较差异无统计学意义(P>0.05)。结论:多学科诊疗模式下局麻为主的多种镇痛镇静方式下PFNA手术的方法是安全可行的,局麻手术患者年龄更大,并且ASA≥Ⅲ级患者的比例更高,对于部分老年高危患者局麻比全麻手术是更好的适应证。展开更多
Objective: To evaluate the efficacy and safety of percutaneous microwave coagulation therapy (PMCT) for patients with primary and metastatic hepatic tumors.Methods: The enrolled 100 patients with 186 tumor nodules who...Objective: To evaluate the efficacy and safety of percutaneous microwave coagulation therapy (PMCT) for patients with primary and metastatic hepatic tumors.Methods: The enrolled 100 patients with 186 tumor nodules who underwent PMCT included 79 cases of primary or recurrent liver cancers and 21 cases of metastatic liver cancer. The tumors were divided into two groups according to the tumor size in diameter: group A, 0.5 cm?<3 cm; group B, ≥3 cm?<5 cm. Under local and/or epidural anesthesia, a single percutaneous microwave antenna (or two antennas array applicator) was inserted directly into the tumor in the liver for thermo-coagulation with the aid of ultrasound guidance.Results: Among the 186 lesions in 100 patients with primary and metastatic liver cancers, in group A, 123 (66%) were coagulated once. A Follow-up of 6–12 months demonstrated that 112 lesions (91%) showed no local recurrence by CT or MRI; In group B, of the 63 lesions (33.87%) coagulated twice, 31 (49%) showed no local recurrence by CT or MRI during a follow-up of 6 months. There were no serious clinical side effects or complications in all the PMCT patients.Conclusion: PMCT gives satisfactory curative effect on tumors with <3 cm in size. It is partly effective on lesions ≥3 cm?<5 cm in size. It is a minimally invasive and effective therapy, can be used safely in the field of percutaneous hepatis surgery, and carried out even in patients with poor liver function. Key words hepatocellular carcinoma - microwave - coagulation - therapy展开更多
In the present paper, the authors make a review on the progresses of acupuncture anesthesia (AA) from ① historical development, ② research on acupuncture combined with local anesthesia; ③ research on acupuncture co...In the present paper, the authors make a review on the progresses of acupuncture anesthesia (AA) from ① historical development, ② research on acupuncture combined with local anesthesia; ③ research on acupuncture combined with epidural anesthesia; and ④ research on acupuncture combined with general anesthesia. Compound acupuncture anesthesia provides a new anesthetic measure for surgical operations and has a definite analgesic effect and many advantages, and should be investigated further.展开更多
文摘目的:比较局麻和全麻下行股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗高危患者股骨转子间骨折的临床疗效。方法:2018年2月至2019年2月因股骨转子间骨折行PFNA手术的32例患者,16例局麻下行PFNA手术,男9例,女7例,年龄54~98(82.43±9.30)岁,住院时间(10.94±5.30)d;16例全麻下行PFNA手术,男6例,女10例,年龄51~83(72.69±9.48)岁,住院时间(12.88±4.12)d。记录患者性别、年龄、骨折AO分型、术前VAS疼痛评分、术前ASA病情分级、术后第1天静息状态VAS评分、住院费用及住院时长。结果:32例患者术后均恢复较好,伤口愈合良好,恢复下肢活动能力。患者术后平均随访时间4.6个月。两组患者年龄差异有统计学意义(P<0.05);患者性别比、骨折AO分型、术前VAS疼痛评分比较,差异无统计学意义(P>0.05)。两组ASA分级比较差异无统计学意义(P>0.05),但两组ASA≥Ⅲ级患者比较差异有统计学意义(P<0.05)。局麻组术中VAS疼痛评分4.19±1.50,患者尚可忍受。两组术后第1天静息状态VAS评分、平均住院费用及平均住院时长比较差异无统计学意义(P>0.05)。结论:多学科诊疗模式下局麻为主的多种镇痛镇静方式下PFNA手术的方法是安全可行的,局麻手术患者年龄更大,并且ASA≥Ⅲ级患者的比例更高,对于部分老年高危患者局麻比全麻手术是更好的适应证。
文摘Objective: To evaluate the efficacy and safety of percutaneous microwave coagulation therapy (PMCT) for patients with primary and metastatic hepatic tumors.Methods: The enrolled 100 patients with 186 tumor nodules who underwent PMCT included 79 cases of primary or recurrent liver cancers and 21 cases of metastatic liver cancer. The tumors were divided into two groups according to the tumor size in diameter: group A, 0.5 cm?<3 cm; group B, ≥3 cm?<5 cm. Under local and/or epidural anesthesia, a single percutaneous microwave antenna (or two antennas array applicator) was inserted directly into the tumor in the liver for thermo-coagulation with the aid of ultrasound guidance.Results: Among the 186 lesions in 100 patients with primary and metastatic liver cancers, in group A, 123 (66%) were coagulated once. A Follow-up of 6–12 months demonstrated that 112 lesions (91%) showed no local recurrence by CT or MRI; In group B, of the 63 lesions (33.87%) coagulated twice, 31 (49%) showed no local recurrence by CT or MRI during a follow-up of 6 months. There were no serious clinical side effects or complications in all the PMCT patients.Conclusion: PMCT gives satisfactory curative effect on tumors with <3 cm in size. It is partly effective on lesions ≥3 cm?<5 cm in size. It is a minimally invasive and effective therapy, can be used safely in the field of percutaneous hepatis surgery, and carried out even in patients with poor liver function. Key words hepatocellular carcinoma - microwave - coagulation - therapy
文摘In the present paper, the authors make a review on the progresses of acupuncture anesthesia (AA) from ① historical development, ② research on acupuncture combined with local anesthesia; ③ research on acupuncture combined with epidural anesthesia; and ④ research on acupuncture combined with general anesthesia. Compound acupuncture anesthesia provides a new anesthetic measure for surgical operations and has a definite analgesic effect and many advantages, and should be investigated further.
